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PubMedDate not supplied

Cytologic diagnosis of suppurative cholecystitis due to Candida albicans and actinomyces. A report of 2 cases.

BACKGROUND: Cholecystitis is a common inflammatory disease of the gallbladder. Actinomycosis and candidiasis of the gallbladder are uncommon causes of acute cholecystitis. There has been no previous report on the cytologic diagnosis of actinomycosis and candidiasis from aspirated gallbladder bile intraoperatively. CASES: Purulent bile was intraoperatively aspirated from the gallbladder of 71-year-old Indian and a 30-year-old Australian woman. The specimens were sent for cytologic examination. The first case revealed sulphur granules characteristic of Actinomyces spp. The second case showed budding spores and pseudohyphae of Candida spp. Pure colonies of Candida albicans grew from the bile culture. CONCLUSION: Actinomycosis and candidiasis rarely cause acute suppurative cholecystitis. Initial diagnosis can be made by cytologic examination of the aspirated purulent bile intraoperatively.

Actinomyces↗
PubMed2000

Validation of outcomes survey for adults with chronic suppurative otitis media.

Currently, there is no valid, disease-specific outcomes measure to evaluate health impact and treatment effectiveness for patients with chronic suppurative otitis media (CSOM). The Chronic Ear Survey (CES) is a new, disease-specific outcomes measure for CSOM that was administered in a prospective manner to 91 patients with CSOM. It was then validated according to established criteria for reliability, validity, and sensitivity to clinical change by correlation with objective data and self-assessment questionnaires such as the Hearing Handicap Inventory for Adults (HHIA) and the generic 36-Item Short-Form Health Survey (SF-36). Significant correlations between subscale scores of the CES and audiometric data and between subscale scores of the HHIA and SF-36 were found. The standardized response mean for the CES total score was 0.42, indicating moderate sensitivity to clinical change. Overall, results demonstrated that the CES is a reliable and valid instrument for investigation of health status and health-related quality-of-life outcomes.

Adult↗
PubMed2000

Correlation of pure tone audiogram results and hearing benefit of tympanoplasty for chronic suppurative otitis media.

The aim of this study was to evaluate the correlation between pure tone audiogram results and the subjective sensation of hearing benefit of patients who had tympanoplasty for chronic suppurative otitis media. This is a prospective study of 115 patients who had tympanoplasty between 1992 and 1994. The outcome, including a pure tone audiogram and the subjective sensation of hearing benefit, was evaluated at 1 year after operation. There were 63 (55%) patients with subjective hearing benefit after the tympanoplasty. The subjective sensation of hearing benefit correlated with the magnitude of the air conduction (AC) threshold reduction, and increased from 39% for an AC reduction of less than or equal to 10 dB to 100% for an AC reduction of more than 30 dB. The effect of the interaural AC threshold difference on the subjective sensation of hearing was not significant; improvement was felt by 92% of patients when the operated ear became the better hearing ear, and by 73% of patients when the operated ear remained the worse hearing ear. There was considerable discrepancy between the subjective hearing benefit and the pure tone audiogram results. A combination of parameters, including the air-bone gap, the AC threshold, and the subjective hearing change, is recommended in reporting the results of tympanoplasty.

Audiometry, Pure-Tone↗
PubMed1989

Quantitative bacterial cultures and beta-lactamase activity in chronic suppurative otitis media.

Aspiration of the exudate through open perforation was performed in 54 children with chronic suppurative otitis media. Eighty aerobic and 81 anaerobic isolates were recovered. Aerobic bacteria only were involved in 20 patients (37%), and anaerobic organisms only in seven (13%). Mixed aerobic and anaerobic isolates were recovered from 27 patients (50%). The most common bacteria isolated were anaerobic gram-positive cocci, Bacteroides melaninogenicus group, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Staphylococcus aureus. There were 45 beta-lactamase-producing bacteria (BLPB), 30 aerobes, and 15 anaerobes recovered from 38 patients (70%). beta-Lactamase activity was detected in 30 of the 38 ear aspirates (79%) that contained BLPB. All but one of these organisms were in excess of 10(4) colony-forming units/mL. The detection of beta-lactamase activity in the ear aspirates provides evidence of the role of BLPB in the failure of penicillin therapy to eradicate chronic ear infection.

Adolescent↗
PubMed1992

Neutrophil elastase and its complex with alpha 1-antitrypsin in the pathogenesis of chronic suppurative otitis media.

Neutrophil elastase (NE) and its complex with alpha 1-antitrypsin were quantified in ear discharges from 15 patients with chronic suppurative otitis media (CSOM), and their levels were compared to those in middle ear effusions from 10 pediatric patients with chronic otitis media with effusion (OME). The localization of immunoreactive NE was also examined by immunocytologic study. The mean value of total NE was 161.8 +/- 29.5 micrograms/mL in CSOM, which was significantly higher than that in OME (16.5 +/- 6.7 micrograms/mL). The mean value of NE-alpha 1-antitrypsin complex was 13.7 +/- 8.8 micrograms/mL in CSOM and 7.8 +/- 4.0 micrograms/mL in OME. There was no significant difference between culture-positive and culture-negative samples in CSOM. Immunoreactive NE could be observed in the neutrophils of ear discharges, and extracellular release of NE was also observed. Ear discharges in CSOM contain a considerable amount of uncomplexed NE, of which the level does not depend on active bacterial infections. Uncomplexed NE seems to play a role in the chronicity of CSOM.

Adolescent↗
PubMed1998

Treatment of chronic suppurative otitis media with topical ciprofloxacin.

To date, only ofloxacin has been approved by the US Food and Drug Administration for treatment of ears with a nonintact tympanic membrane. The purpose of this study was to determine the safety and efficacy of topical ciprofloxacin hydrochloride in the treatment of experimental chronic suppurative otitis media caused by Pseudomonas aeruginosa infection in cynomolgus monkeys. Forty adult cynomolgus monkeys were divided into 4 equal groups, and their ears were challenged with P aeruginosa, drained for 3 weeks, then treated twice daily for 4 weeks with 1 of 4 randomly assigned agents: 1) ciprofloxacin, 2) saline, 3) Cortisporin, or 4) vehicle. The animals were followed up with auditory brain stem response testing, culture, otoscopy, and histopathology. Both ciprofloxacin and Cortisporin treatment resulted in a significantly more rapid rate of clearance of P aeruginosa as compared to treatment with saline (100% versus 20%). Eradication was not associated with resolution of otorrhea after a 4-week period of treatment. There were no significant changes in auditory brain stem response wave latencies for any of the treatment groups. Histopathologic data revealed that there was no statistically significant difference in the amount of outer hair cell loss for the ciprofloxacin group as compared to the control ear and other treatment groups. We conclude, therefore, that topical ciprofloxacin is not ototoxic and is effective in sterilizing the otorrhea, but does not promote resolution of the drainage, in this animal model.

Administration, Topical↗
PubMed1999

Antibiotics in chronic suppurative otitis media: a bacteriologic study.

Conservative medical management of chronic suppurative otitis media (CSOM) is an important step in achieving a dry ear. Topical antibiotic ear drops and aural toilet form the mainstay of medical management of noncholesteatomatous CSOM. This study analyzes the causal organisms and their sensitivity to various antibiotics. Out of 382 swabs examined, the major organisms isolated were Pseudomonas aeruginosa (27.2%), followed by Staphylococcus aureus (23.6%). The sensitivity of P. aeruginosa was 100% to ceftazidime, 98.9% to ciprofloxacin, 96.3% to gentamicin, and 95.4% to polymyxin B, whereas the sensitivity of S. aureus was 98.6% to ciprofloxacin, 97.4% to cloxacillin sodium, 96.5% to cotrimoxazole, and 90.7% to gentamicin. Pseudomonas aeruginosa was almost completely resistant to ampicillin (97.6%) and chloramphenicol (96.6%), whereas S. aureus was almost completely resistant to ampicillin (73.8%) and polymyxin B (98.3%). Among the available topical antibiotic preparations for use in the ear, we found that ciprofloxacin and gentamicin are the best choices.

Adolescent↗
PubMed1981

Acute suppurative otitis media in children. Diversity of clinical diagnostic criteria.

Practicing pediatricians were surveyed via mailed questionnaire and a review was made of the pertinent literature in an attempt to identify suitable criteria for making the clinical diagnosis of acute suppurative otitis media (ASOM) in children. Clinical diagnostic criteria were described in only 26 of the 43 studies reviewed; 18 different sets of criteria were used. Use of identical criteria in more than one study was usually the result of multiple publications by particular authors rather than agreement between two investigators. One hundred and sixty-five questionnaire respondents proposed 147 different sets of criteria. Only 11 criteria sets were proposed by more than one respondent, and no single set was listed by more than six respondents. Greater standardization of clinical diagnosis is desirable, but difficult to achieve and will require additional studies to correlate clinical findings with objective measures of diagnosis, such as tympanocentesis.

Acute Disease↗
PubMed2004

Bacteriological profile in chronic suppurative otitis media in Eastern Nepal.

Aural swabs were collected from 250 patients with chronic suppurative otitis media (CSOM) (tubotympanic disease). Duration of ear discharge was more than 6 months for culture and sensitivity test. The disease was unilateral in 178 (71.2%) and bilateral in 72 (28.8%) patients. From a total of 322 aural swab cultures, 324 organisms were isolated with predominance of Pseudomonas aerugimosa (36.4%) followed by Staphylococcus aureus (30.2%). All the isolated Gram-negative organisms showed in vitro sensitivity to ciprofloxacin, amikacin, ofloxacin, and gentamycin whereas cloxacillin, ofloxacin, erythromycin, ciprofloxacin, gentamicin and tetracycline were more effective against Gram-positive isolates. Most isolates were resistant to amoxycillin. It is concluded that ciprofloxacin is preferred to aminoglycosides as an important tool in the treatment of CSOM because of its lower cost, lack of ototoxicity and availability as topical oral preparations.

Administration, Topical↗
PubMed1988

The CT findings of acute thyroiditis and acute suppurative thyroiditis.

Although acute thyroiditis often has a distinctive clinical presentation, this relatively uncommon entity can occasionally be confused with other inflammatory processes. In general, the earlier the diagnosis of acute thyroiditis is established, the lower is the frequency and severity of its attendant complications. Computed tomography (CT) is an extremely useful modality in establishing the diagnosis early because it can evaluate iodine content of the thyroid gland and provides more accurate mapping than ultrasound and nuclear medicine techniques. Three patients with acute thyroiditis--two with suppuration--are presented and the CT findings and clinical aspects of this disease are reviewed.

Acute Disease↗
PubMed1994

Chronic suppurative otitis media.

OBJECTIVE: To review various aspects of chronic suppurative otitis media (CSOM). DATA SOURCES: A MEDLINE search and extensive review of articles provided the information for this review. DATA EXTRACTION: Studies describing the epidemiology, microbiology, risk factors, pathology, diagnosis, treatment, complications, and recurrence of CSOM were included. DATA SYNTHESIS: Pseudomonas aeruginosa and anaerobes are the most predominant bacteria found in CSOM. Treatment with otic, oral, or parenteral drugs (e.g., neomycin/polymyxin B/hydrocortisone otic, ciprofloxacin, ceftazidime, or aminoglycosides) should be guided by ear fluid culture results. Prompt treatment with effective and safe antibiotics may prevent complications of CSOM. CONCLUSIONS: Treatment of CSOM has improved as a result of availability of effective otic and oral antibiotics. Treatment of the anaerobic infection with antibiotics should be studied further.

Chronic Disease↗
PubMed1998

Fatal suppurative mesenteric thrombophlebitis caused by an Enterococcus faecalis highly resistant to aminoglycosides: case report.

A 56-year old man with non-Hodgkin's lymphoma and biliary tract endoprosthesis, developed chronic bacteremia caused by Enterococcus faecalis with high-level resistance to gentamicin and streptomycin. The sources of bacteremia were a device-associated biliary tract infection, a suppurative thrombophlebitis of the confluence of the superior mesenteric vein with the splenic vein as well as multiple liver and pancreatic abscesses. Despite antibiotic therapy and multiple drainages of abscesses, the patient died due to overwhelming infection.

Anti-Bacterial Agents↗
PubMed2000

Ceftazidime for outpatient parenteral antibiotic therapy (OPAT) of chronic suppurative otitis media due to Pseudomonas aeruginosa.

The number of patients receiving parenteral antibiotic therapy outside the hospital (OPAT) is growing rapidly, not only because of financial considerations, but also to limit the risk of nosocomial infections, hospitalization trauma, and to improve the quality of life. The same benefits of OPAT have recently been extended to pediatric patients. In the present study, the efficacy and safety of OPAT was evaluated in 52 children (age range 6-12 years) affected by chronic suppurative otitis media (CSOM) whose parents were deemed compliant. Otorhinolaryngologists and infectious disease specialists (IDS) cooperated in diagnosing, managing patients and being available 24 hours a day for family consultation. Bacteriological examination of ear exudate was carried out before antibiotic treatment. For all 52 children the infection was caused by Pseudomonas aeruginosa in vitro sensitive to ceftazidime. Ceftazidime was administered at the dosage of 500 mg b.i.d. i.m. at the patient's home according to a self administration model for 7-10 days. All patients returned every other day during the treatment course for clinical observation and cleansing of the ear, and 30 days after the end of the treatment (follow-up). Complete clinical cure and bacteriological eradication were observed in 35 patients (67%), clinical improvement in 12 (23%). No side-effects or hearing impairment were reported at clinical and audiometric check-ups; compliance was absolute. Our data suggest that children affected by CSOM can be managed as outpatients by a cooperative team of otorhinolaryngologists and IDS.

Ambulatory Care↗
PubMed2001

Fourth branchial arch fistula and suppurative thyroiditis: a life-threatening infection.

A potentially life-threatening case of recurrent left-sided thyroid abscess formation secondary to a fourth branchial arch sinus fistula is presented. The patient developed a reversible left vocal fold palsy during an acute episode of suppurative thyroiditis requiring a temporary tracheostomy due to a compromised airway. Investigations commonly used to demonstrate this anomaly may fail to confirm the diagnosis as in the case presented and exploratory surgery with excision of the fistulous tract should still be considered. We describe a method of repairing the pharyngeal opening to reduce the risk of recurrence or pharyngeal leak.

Adult↗
PubMed2003

Computed tomography in suppurative ear disease: does it influence management?

The value of high resolution computerized tomography (CT) prior to routine mastoid surgery for cholesteatoma remains controversial. Doubts about sensitivity and specificity, in detecting the extent of underlying pathology and in predicting asymptomatic complications, prevent widespread adoption. This retrospective study looks at the influence of pre-operative scanning on the surgical management of chronic suppurative otitis media over an 18-month period. The radiological findings determined the choice of surgical approach, but contributed less to the decision to operate and the prediction of potential hazards. CT is of most value when the otologist can be flexible in surgical technique, tailoring it to imaging findings.

Cholesteatoma↗
PubMed2002

[Acute suppurative thyroiditis in 7 year-old girl with piriform sinus fistula].

A 7 year-old girl was admitted to our hospital with high grade fever and redness, swelling and tenderness in left neck. CT scan revealed cyst formation (4.5x3 cm) in left lobe of thyroid with swelling of surrounding lymphonodes. We diagnosed her as acute suppurative thyroiditis and treated her with intravenous antibiotics infusion and incisional drainage. After the treatment, the clinical course was uneventful. Pharyngograph revealed left piriform sinus fistula.

Acute Disease↗
PubMed2004

Subjective evaluation and overall satisfaction after tympanoplasty for chronic simple suppurative otitis media.

A questionnaire survey was conducted in 324 patients with chronic, simple, suppurative otitis media who had undergone tympanoplasty 6 months or more previously to investigate post-operative hearing, tinnitus, vertigo, occlusive feeling of the ear and otorrhea. In addition, the overall satisfaction with tympanoplasty was assessed by VAS value. Subjective hearing improvement was observed in 73.1% of the patients whose hearing was poor and in 50% of those whose hearing was good before the operation. The degree of satisfaction assessed by VAS value corresponded with the subjective hearing assessment. As to tinnitus, 66.2% of the patients became aware of the disappearance or alleviation of symptoms. In the case of patients who had tinnitus before the operation, the degree of awareness of tinnitus and the degree of satisfaction assessed by VAS value coincided. However, no changes in the VAS value were observed in those who did not have tinnitus before the operation. As for vertigo, 30.5% of the patients who had vertigo preoperatively became aware of the disappearance of the symptoms after the operation. The degree of satisfaction assessed by VAS value corresponded with the presence or absence, severity and frequency of vertigo. As to the fullness of the ear, alleviation of the symptoms was subjectively noted by 85.9% of the patients who had symptoms before the operation. The degree of satisfaction assessed by VAS value corresponded with the severity of the symptoms in those who had symptoms before the operation. As for otorrhea, the disappearance of the symptoms was subjectively noted by 85.5% of the patients who had otorrhea before the operation. The degree of satisfaction assessed by VAS value corresponded with the post-operative changes in otorrhea. Based on the above results, it was assumed that the patients placed greatest expectation on hearing improvement when they underwent tympanoplasty. VAS is considered a useful method to evaluate the degree of satisfaction of patients after surgery.

Adolescent↗